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Ambulatory Surgery Center Billing
An ASC case is usually three claims: the surgeon's professional fee, anesthesia, and the facility fee. Medicare pays an ASC facility claim at place of service 24, and only for procedures on the ASC covered list. Vector Medical Billing, in Jamaica, New York, keeps the facility claim off the surgeon's claim and checks that list before the case is billed to Medicare.
98%Published NCR
24hClaim Submission
BAASigned with every client
AAPCCertified coders
AHIMACertified coders
E&OErrors and omissions insured
50 StatesRemote billing nationwide
Monthly fee
What ASC billing includes
Facility billing for an ambulatory surgery center, with the surgeon and anesthesia left on their own claims.
Medicare ASC facilities bill on a CMS-1500 (837P) with place of service 24. Many commercial plans ask for a UB-04 instead. The audit sets the form per payer before cases drop. A procedure Medicare has not placed on the ASC covered procedures list does not get an ASC facility payment from Medicare. When more than one procedure is payable on the same day, Medicare pays the highest ASC rate in full and the additional procedures at half. Implants are often packaged into that facility rate; a few are paid separately, and the claim follows the indicator for that code rather than a default implant line. The surgeon's global fee, and the anesthesiologist's time, are not lines on the facility claim.
The fee is a percentage of net collections. The written rate is on pricing. Credentialing, a retrospective coding audit, and old A/R stay separate engagements.
What sits on this fee
- Facility claim only, separate from surgeon and anesthesia
- Medicare place of service 24 and the ASC covered procedures list
- Multiple procedures at the Medicare 100 percent / 50 percent pattern when that payer uses it
- Implant lines only when that code is separately payable
Where ASC facility claims fail
The case happened. The facility fee was mixed with the surgeon, or the code was never payable in an ASC.
Surgeon and facility on one claim
The professional global fee and the ASC facility fee are different tax IDs and different payments. Combining them leaves one side unpaid. Anesthesia is a third claim.
Procedure not on the ASC list
Medicare will not price an ASC facility fee for a code that is not on the covered procedures list. Those cases need a different site of service, not a modifier that forces the ASC rate.
Implant always added
Most implant costs are inside the Medicare ASC rate. Adding the supply because the invoice exists double-counts it. A separately payable device is added only when that procedure's payment rules say so.
How an ASC facility claim is built
Three professionals can touch one case. This page is the facility fee.
| Check | How Vector handles it |
|---|---|
| Medicare form | CMS-1500 / 837P, place of service 24. |
| Commercial form | UB-04 when that plan's contract requires an institutional claim. Confirmed per payer. |
| Covered list | Medicare cases checked against the ASC covered procedures list before billing. |
| Multiple procedures | Highest-paying procedure at the full ASC rate; additional procedures at half, when the payer uses Medicare's method. |
| Surgeon and anesthesia | Billed by those practices, not appended to the facility claim. |
Other practice shapes: Hospital outpatient · Anesthesiology · Orthopedic surgery.
Not inside the monthly percentage
The monthly cycle bills claims that are already in the system. These are scoped on their own.
Written rate
The fee is a percentage of net collections. No setup fee on the monthly cycle. Month to month. The written rate follows volume, payer mix, and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
Separate work
The surgeon's professional billing, anesthesia billing, implant invoices that are not separately payable, and old facility A/R are outside the ASC facility percentage unless the engagement says otherwise.
Audit ASC facility claims against the covered list and the surgeon's separate bill
Send the practice shape, monthly visit or case volume, top payers, and the EHR name. We reply with what the open A/R shows and a written rate.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
ASC billing questions
Straight answers for this practice shape.
Do you bill the surgeon and the ASC on one claim?
No. The facility fee, the surgeon's professional fee, and anesthesia are separate claims.
What form does Medicare want?
An ASC facility bills Medicare on a CMS-1500 with place of service 24. Commercial plans are confirmed one by one; many want a UB-04.
What if the procedure is not on Medicare's ASC list?
Medicare does not pay an ASC facility fee for that code. The case is not forced onto an ASC claim with a modifier.
How are two procedures the same day paid?
Under Medicare's ASC method, the highest-paying procedure is paid at the full rate and the others at half. Commercial contracts are checked before that pattern is assumed.
How is the fee set?
A percentage of net collections on the facility book. No setup fee. Month to month. The written rate follows case volume and payer mix.